Brother refuses to call hospice, what are my options?


My brother lives with our Dad, they are 90 minutes away, IF there is no traffic. Dad was diagnosed, and had surgery for, glioblastoma brain tumors in April. He was released home, to my bother's care, on April 26th. I've been going up Sundays-Tuesdays to help take care of Dad so my brother can get out of the house and take a break.

My brother and I don't get along well, we had horrible fights while Dad was in the hospital. I didn't start going up right away, but we'd managed to keep a truce going so I started going up to help in June. Mostly because I go up, don't say much about what I see, and don't ask questions. But things have changed and it's really hard not to speak my mind. My Dad's symptoms, he is 75, have returned and both my brother and I feel he's getting very close to passing. Up until now, my father didn't want hospice and even though I advocated for it early on, my brother backed my father's wishes (which, admit, I was also willing to do initially).

My father has developed a sore on his back that festered. It took my brother forever to take my Dad to the doctor (admittedly, my Dad fights going anywhere) and he was put on antibiotics and sent home with instructions to change the gauze every day. This past weekend, the antibiotics ran out, though I found two on the floor around his bed, along with other pills not taken. My brother cancelled the follow up appointment on 4/27, stating he couldn't get Dad to the doctor, but then told me the wound was festering again. I have suggested, told, informed, begged, for him to call hospice (even got Dad's permission!) because if Dad can't get to the doctor, my understanding is hospice can arrange for care at the house. As of Friday, he still hadn't called and when I questioned him as to why, he became very angry and we had a fight resulting in his hanging up on me.

My Dad is very close to death. How close I'm not sure because he still consumes a small amount of food and fluids each day. He sleeps most of the time, but is awake and "with it" enough to tell you he has no desire to wear Depends, even though his incontinence is bad enough to soak the linens once a day or more. He is now having problems swallowing, which makes pill taking more than difficult. His dexterity and ability to concentrate on simple tasks is reminiscent of his post-surgical stay in the hospital. Also, his speech is more and more slurred each day.

So that's the brief history, this (these) is (are) my problem(s) and I'm hoping you all can help me work through it:
1. I don't understand why my bother won't call Hospice, even though they can help with many of the issues around my Dad's care. If I push on this issue, my brother becomes angry and volatile. In response, once he starts cussing at me, and after keeping my cool for about 3 attempts, I will start yelling back (and cussing, too), none of which is productive.
2. The wound on my Dad is festering again the first time it got bad really quickly. I don't know how much time my Dad has, but I'm worried the infection is bad for his already compromised immune system.
3. I'm afraid to go up tomorrow (Sunday) to help care for my Dad because: a) I can't provide the kind of care he needs by myself, and b) I'm now concerned (again) to be alone in a house with just my Dad and brother. I've never been concerned about him deliberately hurting our Dad, but me? I can only be there if I'm not questioning anything.
4. Isn't this negligence? Though I'm willing to support my brother weekly to give him a break, I'm not willing to support medical negligence.
5. Maybe Dad is close enough to passing that treating the wound is irrelevant, but a medically qualified person should diagnose that, right?
6. Back to question #1, WHY WON'T HE CALL HOSPICE?

And before you ask, my brother has primary care, is Executor of the will, AND has POA. He is there with all the history, the meds, everything, I think he SHOULD be the one to call. It comes with the position. Yes, I could call. BUT, this will result in the likelihood of not being able to go up and see my Dad at all. Not only will my brother portray it that I am a troublemaker, but my Dad will agree with him and be angry with me, too (yes, they are that tight).

One could argue that Dad being angry with me is a fare exchange for getting him some of the care he is currently lacking, but if he is close to passing, is it worth starting a war? Which brings me back to my issues with not having Hospice on board.

I'm so close to this and have been through it so many times, I'd really appreciate some thoughts and advice.

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Hospice WILL treat an infection, especially if it causes discomfort. My mother just got on hospice, and has uti's all the time, and they said, yes, antibiotics will be given. But no other "fixes".
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A hospice facility would be a totally different situation but with it's own set of challenges.
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Eyerish, I see your points now. I was thinking of hospice in a hospice facility, not at home.
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If dad goes on hospice the brother would have to be on board since he lives with dad. Brother would have to agree because he's the one who will have to let the hospice staff into the house, he's the one who will have to take all the calls from hospice staff who are planning on coming by and he's the one the hospice staff will have to discuss the father with.

I think the father sounds like he would benefit from hospice but since the brother lives there and is the primary caregiver I feel like he has to be on board with it.

But let's say that zebra calls in hospice without her brother's consent and/or support. Hospice has to go to the house (where the brother and the father live) to assess the father. How is hospice going to get into the door if her brother is so against it? And if the brother is as volatile as zebra alluded to why purposely antagonize him by ambushing him with a doorstep full of people from hospice? Zebra's hesitant to go over there as it is now.

I sympathize with zebra and I'm sure she's very frustrated. She should have some say in the care of her father but as long as her father is living with her brother and her brother is the primary caregiver her hands are tied when it comes to bringing in extra services to the house if the brother doesn't want them. I'm not saying I agree with the brother. Hardly. But it's his house (or if it's not his house then he is at least living there while caring for the father) and zebra can't force her brother to participate in hospice services for their dad.
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I would call EMS and let them assess the situation. Then you've covered yourself for having knowledge of a somewhat dire medical situation and not sought immediate help.
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Garden, I understand what you are saying and looked again, the title says, "Durable Power of Attorney - Section 3" I also have a "Living Will or Directive to Physicians". The later includes wording like, "at any time I should have an incurable injury..." The operative word being incurable. But I understand what is being suggested, that the wording of the POA-3 might be interpreted as meaning no treatment of any condition that may prolong his life, regardless of whether or not the injury, in this case the back sore, is treatable.

I guess the questions to my brother should be, "Is this your interpretation?", "Is not having antibiotics okay with Dad?", AND, "Does the doctor have a copy of this and is it being interpreted the same way by her?" Does that seem correct?
Because if the doctor doesn't interpret it that way, we're back to square one. Though it may be a moot point because he hasn't delivered a copy of the document to her. The only reason I have a copy is because I took pictures with my phone.
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Zebra, just to clarify, a Durable Power of Attorney addresses legal and financial issues. The excerpt you wrote sounds more like it's from an Advanced Directive, or Living Will, which people sometimes also call a POA.

I think the wording is actually open to interpretation, depending on the patient's diagnosis and what will merely ease his/her pain and discomfort but does not address curing a specific condition. Whether that would include antibiotics is something I don't know. But I'm sure others here have had more experience and could provide a more helpful answer.

But you're on the right track. Good for you!
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Thank you all for your input! I've already learned a few things and that is exactly what I was hoping for! I actually had a longer answer typed, but then erased it. I think before getting back to some other issues, we should start with the question about Dad's wishes...He signed a Durable POA and marked the following:

"If I should be in incurable or irreversible physical condition with no hope of recovery, I do not want any treatment that will merely prolong my dying. Thus, I want my treatment limited to medical and nursing measures that are intended to keep me comfortable, to relieve pain and to maintain my dignity."

I thought that meant no more chemo or radiation and pertained to his actual cancer diagnosis. Does that wording include no antibiotics?
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If you choose Hospice, be aware they will only treat pain and delirium. They will not send to the ER, they will not attempt to treat infection, they use only their nurses and hospice doctor. So now, you find out what Dad's wishes are. Is he fed up with treatment of any kind? Will he accept Hospice or throw them out? Are you ready to say no more 911 calls, no more ER, just comfort and letting nature take it's course? That includes infection, flu, diarrhea, dehydration?
You have to be sure, or you panic and call 911 and Hospice stops services.
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Eyerish, why would you think that the brother has to be agreeable to hospice b/c he's the caregiver? I'm not challenging your position, just trying to understand. If anything, it seems he would have a higher duty and obligation to his father because he is his caregiver.

Zebra wrote that her brother has a "POA" but didn't state whether it's medical or durable. Regardless, he would have a fiduciary capacity to carry out any responsibilities in a legal and proper manner, and I would think that he's not doing so, whether willingly or because he's not able to see clearly.

I'm not sure though that having his father living in his house gives him so much control that he alone can sign up for hospice.

Just interested in hearing your thoughts on this issue.
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